Mail: Health New England, Human Resources, One Monarch Place, Suite 1500, Springfield, MA 01144-1500

Fax: (413) 233-2747

E-mail: humanresources@hne.com

For more details on the openings that interest you, please check below.

Medical Director

Large Group Sales Executive

Medicare Program Administrator

Provider Relations Representative

Health Services Manager

Medical Director

Position Summary:
The Medical Director will have responsibility for utilization management and quality improvement for the delivery system. Other responsibilities include working with physicians to improve performance and utilization. The Medical Director also participates in physician recruitment, peer activity, credentialing, clinical advisory healthcare teams, and utilization review. The Medical Director shall function as a consultant representing the medical department to internal and external customers, including providers, employers and brokers.

Qualifications:
The successful candidate will have:

• A Medical Degree with board certification, holding an active, unrestricted license to practice, with a minimum of 5 years post-residency clinical/direct patient care experience
• Advanced Management Training
• Practical experience in health care administration and managed care experience desirable 

Additional skills include:

• Demonstrated knowledge of the regulatory environment of managed care
• Excellent clinical, analytical, and facilitation and negotiation skills
• Must show evidence of leadership skills and possess excellent interpersonal skills required to interact with associates and customers.
• Able to exercise good judgment in problem solving and decision-making situations
• Excellent presentation, oral and written communication skills

We are committed to the people we serve, our providers and our community.

For consideration, please e-mail your resume and Curriculum Vitae to: humanresources@hne.com or mail to: Human Resources, Health New England, One Monarch Place, Suite 1500, Springfield, MA 01144-1500, fax: (413) 731-5275.

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Provider Relations Representative

Position Summary:

This position serves as the primary liaison to HNE’s provider network, providing information and training on new products & initiatives; ensuring provider compliance with regulatory requirements and HNE contractual obligations; and responding to and resolving provider issues, questions and concerns.  Ensuring providers have accurate and up-to-date information, and addressing their issues and concerns in a timely manner, has an impact on providers’ decisions to join or remain part of HNE’s provider network.

Qualifications:

• Associate's Degree in Business or a HealthCare related field and 3-5 five years experience in a managed care or other insurance environment or an equivalent combination of education and experience.
• Strong understanding of managed care, high deductible, indemnity and regulated market products
• Ability to analyze and interpret data
• Strong presentation skills - ability to respond to questions on the spot and remain poised under pressure
• Strong verbal and written communication skills
• Excellent customer service skills
• Solid understanding of HEDIS and NCQA standards
• Proficient with Microsoft Office Suite (Word, Excel and Access)

We are committed to the people we serve, our providers and our community.

For consideration, please e-mail your resume and Curriculum Vitae to: humanresources@hne.com or mail to: Human Resources, Health New England, One Monarch Place, Suite 1500, Springfield, MA 01144-1500, fax: (413) 731-5275.

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Large Group Sales Executive

Position Summary:

Responsible for prospecting and generating sales of national, regional and other large self-insured and fully-insured accounts. This position will sell to companies and organizations whose sizes have the potential to create more than 500 new subscribers to HNE health plans upon the closure of each sale. This will require developing relationships with prospective clients over long periods of time. The incumbent will be responsible for achieving sales objectives for assigned large group prospects. Works closely with the sales manager to develop and implement sales strategies to achieve sales growth of target market.

Qualifications:

A Bachelor's degree plus a minimum of 5 years professional business experience in Sales/Marketing. Healthcare sales and or consulting experience required or an equivalent combination of education and experience.

• Experience in employer stop loss and self insurance
• Excellent interpersonal, communication and negotiation skills, including well-honed public speaking, presentation and influencing skills.
• Ability to present to key decision making executives of clients and their consultants.
• Ability to work independently with a strong results orientation.
• Demonstrated proficiency in sales process and prospecting skills, ability to develop new prospects.
• Can identify and clarify customer needs to develop solution.
• Demonstrated proficiency of benefit plan design, underwriting, financial principles and processes.
• Strong customer service focus.
• Excellent interpersonal and problem solving skills
• Excellent organizational skills
• Familiarity with Microsoft Office Suite
• Valid driver’s license and a personal vehicle.
• Massachusetts Life & Health Producers License (or ability to be licensed)

Position requires use of a personal automobile for traveling on a regular basis to clients. Travel to client corporate headquarters may be required. Meetings, presentations and health fairs may be scheduled beyond core business hours so flexibility of workday hours is a required.

We are committed to the people we serve, our providers and our community.

For consideration, please e-mail your resume and Curriculum Vitae to: humanresources@hne.com or mail to: Human Resources, Health New England, One Monarch Place, Suite 1500, Springfield, MA 01144-1500, fax: (413) 731-5275.

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Medicare Program Administrator

Position Summary:

This position is responsible for the daily administration of Medicare Program operations at HNE through the monitoring of the Health Plan Management System (HPMS) and serving as the liaison to the Centers for Medicare and Medicaid Services (CMS) with their regional and main offices. Individual will monitor and coordinate ongoing efforts/initiatives related to the Medicare Program across the organization. The Medicare Program Administrator will work closely with departments to insure compliance with CMS policies, procedures, and regulations. This position will provide periodic updates to committees, the Directors Team and the Senior Management Team. The incumbent will serve as the point-of-contact for consultants and vendors in support of the Medicare Program at HNE.

Qualifications:

The ideal candidate will have a Bachelor's degree and 3 - 5 years of progressively responsible experience in managed care or healthcare operations and compliance with an emphasis on Medicare is required; experience interpreting CMS regulations and policies is essential; or an equivalent combination of education and experience.

We are committed to the people we serve, our providers and our community.

For consideration, please e-mail your resume and Curriculum Vitae to: humanresources@hne.com or mail to: Human Resources, Health New England, One Monarch Place, Suite 1500, Springfield, MA 01144-1500, fax: (413) 731-5275.

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Health Services Manager

Position Summary:

The Manager of Health Services will be responsible for the supervision and monitoring of the Case Management Team by ensuring compliance with department policies and procedures, project management, and training as needed while staying in alignment with HNE’s mission, vision and corporate values.  The Manager will be responsible for the oversight of all Utilization Management (UM) or Case/Disease Management (CM/DM) processes, and will participate with the Director of HS in the development of Quality Improvement Activities and the oversight of Delegation Agreements. 

Qualifications:

• Bachelor's Degree in Nursing with a current Massachusetts RN license combined with a minimum of 5 years progressively responsible case management and /or utilization management experience. Certification as Case Manager (CCM) preferred.
• Strong knowledge and experience with state licensure, regulatory requirements and NCQA accreditation process
• Demonstrated leadership & negotiation experience
• Project management experience
• Knowledge of data collection, analysis and data presentation methods
• Ability to function independently to establish own and departments work plans and priorities to meet organization goals.
• Ability to adjust to multiple demands & shifting priorities
• Computer literate, particularly in Windows based applications (Word, Excel, PowerPoint, Access)
• Excellent verbal, written and presentation skills
• Problem resolution skills

We are committed to the people we serve, our providers and our community.

For consideration, please e-mail your resume and Curriculum Vitae to: humanresources@hne.com or mail to: Human Resources, Health New England, One Monarch Place, Suite 1500, Springfield, MA 01144-1500, fax: (413) 731-5275.

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